Sleep apnea can be treated and usually does not cost a driver his job, despite the belief that it will, says a leading expert. (Photo: Shutterstock)

When the U.S. Department of Transportation announced in August that it was abandoning a proposed rulemaking for sleep apnea, many in the industry were not pleased. The idea of having government support behind an issue that affects so many truck drivers was quite appealing to carriers.

Even Senate Minority Leader Chuck Schumer (D-NY) pressed DOT to reconsider. “It doesn’t take Albert Einstein to understand why it is so important to begin the process of requiring sleep apnea testing across-the-board and at the federal level,” Schumer said while standing at the Long Island Railroad (LIRR) Mineola station on Tuesday. “We don’t want train engineers with undiagnosed sleep apnea, who actually hold lives in their hands, to fall asleep at the switch and we don’t want big-rig drivers to doze off at the wheel. That’s why NTSB’s recommendations to get this done should be the law of the land and why I have pushed so hard on this subject for years.”

Sleep apnea affects nearly 33% of truck drivers, explains Michael Trufant, head of industrial markets for Aeroflow Healthcare. While DOT declined to press ahead with a sleep apnea rulemaking, there was a significant court case in 2017 that provided carriers some guidance in dealing with drivers believed to be suffering from sleep apnea.

On April 3, the U.S. Supreme Court declined to hear an appeal in a case against Crete Carrier Corp. The carrier had required a driver to take a sleep apnea test, but he refused, so Crete fired the driver. The driver sued under the American with Disabilities Act, but a lower court rule in Crete’s favor. The Supreme Court’s refusal to hear the case left intact the lower court’s ruling.

The implication was power to the carriers to force drivers to take sleep apnea tests. In reality, Trufant tells FreightWaves, most drivers are referred for testing during medical exams either before they get their CDL or upon renewal.

“Certainly there is a cost and liability,” he says, noting that sleep apnea leads to 1,500 deaths a year and $15 billion in associated costs.

During a September Truckload Carriers Association webinar entitled, “Who’s in the Driver’s Seat now?,” Andy Leuthe, senior director of marketing for SmartDrive, rattled off an interesting stat on sleep apnea. Fatigue is the most common cause in 31% of all fatal truck driver crashes, he said.

One of the causes of sleep apnea is obesity, which is prevalent in the truck driver community. According to Kim Beck, vice president of benefits consulting for insurance provider Cottingham & Butler, 60% of those who suffer from obstructive sleep apnea (OSA) have a BMI of 30 or higher – the typical standard for being obese - and 69% of the truck driver population has a BMI above 30. A full 17% have a BMI over 40, which is considered morbidly obese. In one study, 34% of drivers admitted falling asleep at least once while driving and Beck says that 28% of the truck driver population is afflicted with OSA.

“We think that number is actually much higher because there are a lot of undiagnosed cases of sleep apnea,” she says.

Trufant says that anyone with a BMI over 35 or a neck size over 17 inches should be tested. Sleep apnea can cost a carrier as much as $6,000 per driver per year, he notes. “The belief is that sleep apnea drives hypertension, heart disease, [and other health issues],” Trufant says.

For drivers who are sent for sleep apnea testing, it can be a troubling experience, leading many to not seek help when needed. Beck said that not seeking treatment for OSA actually raises health care costs and will end up costing carriers more in the long run, not just in health costs but potentially lawsuits from a driver that injures another due to OSA-related fatigue.

“If things continue like this we are going to have fewer and fewer drivers on the road because they are going to be unable to pass their physicals,” she said. “We believe investing in the right technology and [creating] targeted health programs will save time and money.”

Drivers who are in poor health, she adds, leads to more turnover due to accidents/crashes and higher costs for carriers through crash settlements, insurance and medical claims, legal costs, and lost time and productivity.

“Drivers see this as an expense and a burden, and when they are in this space, they are emotional,” Trufant says. “It just comes down to a management decision based on safety. Data shows that treatment helps.”

He advises fleets that are dealing with drivers to point out the ultimate goal of any sleep apnea program and testing. “The safety manager [should say], ‘we know this is a pain point for you, but ultimately…we want you to go home,” Trufant says.

“A medical examiner typically just says, ‘you need a sleep test’ and sends them on their way,” Trufant says. But, the fear that many drivers have of losing their jobs is not true, he points out. “If they are suspected of sleep apnea, the medical examiner will give them a temporary card until they get tested,” he says. “Ninety-nine percent of obstructive sleep apnea can be treated immediately and it doesn’t pull the driver off the road.”

For fleets that are trying to get drivers into trucks quickly, Trufant says they shouldn’t rush this process. Smart fleets are now creating wellness programs and being proactive in identifying risk associated with issues such as sleep apnea.

Trufant concludes by noting that the industry spends $15 million on crashes each year related to sleep apnea, but treating the driver population suffering from sleep apnea would only cost $11 million.

A sound investment indeed.

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Brian Straight has covered the U.S. trucking and transportation community for more than 10 years, winning numerous regional and national editorial awards, including a Jesse. H. Neal Award. Prior to working on FreightWaves, Brian spent 10 years at industry trade magazine Fleet Owner, and prior to that managed daily newspaper editorial operations.

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